CARE HOMES FOR OLDER PEOPLE
Bracken Lodge 5 Bracken Road Southbourne Bournemouth Dorset BH6 3TB Lead Inspector
Marjorie Richards Unannounced 27 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Bracken Lodge Address 5 Bracken Road Southbourne Bournemouth Dorset BH6 3TB 01202 428777 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr W O`Flaherty Ms V Flemming Ms V Flemming CRH N - Care Home With Nursing 18 Category(ies) of DE(E) Dementia - over 65 (18) registration, with number of places Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 15th December 2004 Brief Description of the Service: Bracken Lodge is a large detached property, situated in a quiet residential area of Southbourne, Bournemouth. The home is positioned within 400 metres level walk from the centre of Southbourne, which offers a wide range of amenities, such as shops, post office, churches, GP surgeries and library. The home is also close to the cliff top and sea. Parking for visitors is available on surrounding roads and there is a good local bus service nearby. Bracken Lodge accommodates up to 18 older people with dementia, who are in need of 24hour nursing and personal care. The property has been converted for use as a care home and is arranged over three floors. A passenger lift is available to assist access between floors. The home has fourteen bedrooms, ten of which are for single occupancy. None of the bedrooms has en-suite facilities, but there are sufficient numbers of communal bathrooms and W.C.s available. The home has a lounge on the ground floor, which also provides a small dining area. This is a the only communal space so recreational facilities are somewhat limited. There are issues over accessability to some rooms but staff make good use of the space available. A secure garden is not available, but there is a a paved patio area, with a water feature and pots of seasonal colourful flowers, where service users can sit out under staff supervision. Service users are encouraged to participate in a range of activities organised within the home. An inter-denominational service is held in the lounge every two weeks and service users are welcome to participate if they wish.
Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven hours on the 25th July 2005 and was one of the two statutory inspections carried out each year. The main purpose of the inspection was to check that the service users living in the home were safe and properly cared for and to check on progress in meeting the many requirements and recommendations from the previous inspection. A tour of the premises took place and a variety of records and related documentation were examined, including the care records for three service users. Time was spent talking with four service users, as well as Ms Flemming, the staff on duty and a visitor to the home, in order to get a real feel of what it is like to live at Bracken Lodge. What the service does well:
Written information about Bracken Lodge is available for prospective service users and their relatives or representatives, to let them know what they can expect from the home and help them decide if Bracken Lodge is right for them. Pre-admission assessments are carried out to ensure that only people whose needs can be met are offered places within the home. Every resident has a care plan, which sets out in detail the individuals care needs and the care that staff are expected to give over each 24-hour period. Assessments and care plans are comprehensive and a good standard of care is provided, with attention paid to detail. Care staff are supported in caring for service users by community healthcare professionals, such as GPs, chiropodists, opticians etc. Staff were seen to be treating service users in a respectful way and carrying out personal care tasks with due regard for privacy and the preservation of dignity. Since the last inspection, staff have received training in dealing with death and dying, to ensure they can offer the best possible care to service users before and after death. Activities are available within the home and an inter-denominational religious service is held in the lounge every two weeks. Open visiting arrangements are in place and one visitor commented that she was always made to feel welcome, no matter what time of day she arrived.
Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 6 A choice of menu is available and the cook is able to accommodate individual taste and preference. Drinks and snacks are available from staff 24 hours a day. A system is in place for dealing with any complaints, but none have been received by the home or the Commission since the last inspection. The home provides a comfortable and safe environment for service users and is clean throughout, with no unpleasant odours. Service users speak well of the staff, The lady who looks after me is very nice. I like it here, the people are kind. Ms Flemming is an experienced Level 1 Registered Nurse. She heads a team of staff, most of whom are experienced in caring for people. Staff spoke highly of the manager, She is a good boss, very fair but firm. She expects good results but helps and supports staff to achieve them. A visitor said, This is a friendly home and expressed continued satisfaction with the way the home is run. Quality Assurance questionnaires have recently been sent out to relatives and some of the service users. Comments from those that have been returned include: - A lovely, happy, well run home. I feel patients are treated with a good balance of respect and humour. Friendly, clean and efficient. What has improved since the last inspection?
Following the previous inspection, there were thirty-two requirements and fifteen recommendations made. For those Standards not examined in full during this inspection, sufficient time was allowed to assess whether or not progress had been made in meeting these requirements. Ms Flemming has worked extremely hard to make the necessary improvements and is commended for now meeting twenty-nine of these requirements in full. Of the remaining three, one was not inspected on this occasion and two were almost met. All fifteen recommendations have also been implemented. The standard of care planning has greatly improved, with all care plans being re-written since the last inspection. Care plans also include information about social needs so that activities can be better planned and, wherever possible, service users and their relatives are more involved in the care planning process. Since the last inspection, one bedroom has been redecorated and work has been carried out, where necessary, to repair window latches and exclude draughts at windows. The laundry door, which was showing signs of rot, has been replaced. Six new armchairs have been purchased.
Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 7 A few windows on the second floor had bars fitted, to prevent the possibility of service users accidentally falling if opening the windows. The bars have now been removed in favour of a less obvious device which limits the distance the window will open for safety purposes, whilst leaving the room looking much more homely. Staffing levels have improved and there are now sufficient staff on duty to meet the needs of service users, including a qualified nurse at all times. The home has implemented a thorough recruitment procedure and carries out appropriate checks on all new staff, to ensure the protection of service users. A staff training programme has been introduced to ensure all staff have the skills necessary for the work they undertake. A member of staff commented, We have done a lot of training lately and I think this has proved helpful to all of us. The Registered Person, Mr OFlaherty, now makes the required unannounced visits to the home at least monthly, in order to form an opinion of the standard of care provided. He prepares a written report on the conduct of the home and a copy of this is forwarded to the Commission. Ms Flemming is studying for her NVQ Level 4 in management and hopes to complete this by September 2005. Now that Quality Assurance systems have been introduced for relatives and some service users, further questionnaires are being planned for other visitors to the home. Fire training for all staff is taking place at the required intervals to ensure that all staff know what to do in the event of fire. What they could do better:
Wherever possible, prospective service users and their relatives or representatives are invited to visit Bracken Lodge before making any decision about whether or not to stay. Service users are admitted to the home on the basis of a four-week trial period. It is recommended that information about opportunities to visit prior to admission and the possibility of a trial period are included in the Service User Guide or Information Handbook. The home now has an Adult Protection policy, which provides a system for identifying and dealing with potential abuse to ensure that service users are protected. This policy is in need of minor amendment, which, when completed, will ensure that any allegations of abuse can be managed effectively. Staff training has been greatly improved since the last inspection, but the records for induction and foundation training are being poorly maintained.
Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 8 These must be kept fully up-to-date in order to evidence that such training is taking place. Induction training should be completed within the first six weeks of employment. Although not assessed on this occasion, the requirement made at the previous inspection regarding staff supervision, is carried forward. No score or outcome has been allocated in respect of this. (Requirements, Standard 36.) Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 and 5. Bracken Lodge does not provide intermediate care, so Standard 6 is not applicable. Information provided about Bracken Lodge and a thorough admissions procedure allows prospective service users to make informed decisions about admission to the home and ensures that only those whose needs can be met by the home are offered places there. The outcome of pre-admission assessments is confirmed in writing, so prospective service users are fully assured that their care needs will be met. Prospective service users and their relatives or representatives are invited to visit the home prior to admission to enable them to assess the facilities and services provided. A trial period is also available before making any decision about whether or not to stay. EVIDENCE: The Statement of Purpose and Service User Guide contain information about the home and its facilities. These documents are accompanied by a very helpful Information Handbook, which is laid out in alphabetical order and is easily readable. The Handbook includes headings such as Activities, Care,
Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 11 Hospitality, Laundry, Meals, Shopping, Telephone and Visiting. There are also answers to “frequently asked questions.” All of this information serves to give a good indication of what a service user can expect from the home. Individual care records are maintained for each service user and three of these were examined. All showed that, prior to moving to the home, care needs had been fully assessed by the manager, Ms Flemming. So that they may feel fully assured about the outcome of the assessment, a letter is sent to the prospective service user (or their relative or representative), confirming that Bracken Lodge can meet their needs. The information contained in preadmission assessments is then used to draw up a detailed plan of care. Wherever possible, prospective service users and their relatives or representatives are invited to visit Bracken Lodge before making any decision about whether or not to stay. Ms Flemming says she encourages such visits as they provide not only an opportunity to assess the facilities of the home but also a chance to ask questions, meet the staff, assess the quality of meals etc. Service users are admitted to the home on the basis of a four-week trial period and brief details are included in the Terms And Conditions/Residents Contract. However, visits prior to admission and the possibility of a trial period are not mentioned in the Service User Guide or Information Handbook. Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 and 11. A care planning system is now in place, which ensures that staff have sufficient information to meet the needs of service users. The health needs of service users are also well met, with evidence of good support from community health professionals. Service users are treated respectfully and care is offered in a way that protects their rights to and dignity. Staff have received training so that, at the time of their death, service users may be assured that they and their relatives will be treated with care and respect. EVIDENCE: All three of the care plans examined followed from the pre-admission assessments made earlier. Since the last inspection, all care plans have been re-written and are now clearly set out, informative about the needs of each resident and how staff are to meet these needs. There is good practice in that day and night care plans are in place to ensure care needs can be met over the whole 24-hour period. Records show that relatives are encouraged to contribute to the development of care plans. Records also demonstrate that care plans are reviewed and updated monthly, or more often where necessary. Discussions with staff show that they are aware of the wider needs of individuals and there is detailed information in the care plan to support this.
Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 13 A detailed social care plan is in place and, where possible, relatives and friends have been involved in providing a life history so that staff are aware of each service users background, past hobbies and interests etc. Such information is very helpful, for instance when planning activities or reminiscence sessions. The three care plans examined show that professional advice is sought appropriately and visits by the GP, chiropodist, optician etc are recorded. Risk assessments are in place and appropriate steps are taken to minimise any risks identified. Staff were observed to be treating service users in a patient and respectful manner and carrying out personal care tasks with due regard for privacy and dignity. One service user commented, I am happy here, I feel safe. Service users were well presented and one commented, They ask me what I would like to wear. I like to look smart. The home has a policy on care of the dying and this has recently been updated. Since the last inspection, all staff have received training in death and dying to ensure they can offer the best possible care to service users, both before and after death. A death and dying care plan is in place for each service user and all known wishes are recorded. One member of staff spoke of a relative who had been supported and enabled to remain overnight at Bracken Lodge in order to spend precious time with a service user who was dying. Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 A range of social activities provides variation and interest for service users and the home also satisfies religious needs with two interdenominational services every month. Visits from family and friends are encouraged but the frailty of many service users means there are only limited opportunities for contact with the community. A flexible approach is taken to the running of the home and service users are helped to have a choice over their lives. The home provides meals that meet service users’ tastes and special dietary needs. EVIDENCE: Since the last inspection, Ms Flemming has sought advice from the Kings Park Community Hospital about suitable activities for service users with dementia. A programme of activities is displayed in the hallway, but some still take place spontaneously to fit in with the wishes of service users. Information about each service users past life, hobbies and interests etc is recorded and Ms Flemming now has a social care plan in place to ensure that activities are tailored to meet individual need. During the inspection, service users were seen enjoying a sing-along, listening to music and playing catch the beanbag with staff. Once a fortnight, an external tutor comes to the home to run a gentle exercise to music class, which is enjoyed by over half of the service users.
Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 15 Staff maintain an “Activities Book” where they record, on a daily basis, all of the activities in which service users have participated. An inter-denominational religious service is held in the lounge every two weeks and service users are welcome to participate if they wish. Ms Flemming says that most of the current service users receive visitors. This was later confirmed in discussions with staff and also evidenced in daily notes and the visitors book. One visitor to the home confirmed that she is always made to feel welcome, no matter what time of day she arrives. The home is currently planning a barbecue, which will take place in August and service users, and their relatives will be invited to attend. Some service users are able to go out with relatives on occasion or for local walks with staff, but many prefer to remain in the home and are now too frail to really enjoy going out very much. Service users are assisted by staff where necessary to help make choices and have some control over their lives. Staff gave examples of some service users preferring to get up early in the morning, whilst others sometimes liked to wait until much later. Care plans provide detailed information to staff, e.g. Prefers to go to bed 10:30 p.m. to midnight. Likes a small light on in her bedroom. Allow her to attempt buttons etc, before tactfully intervening. Encourage her to do as much as possible for herself. Does not like to be rushed. Likes things to be done in her own time, in her own way. Lunch on the day of inspection was pork casserole or steak and onion pie, with mashed potatoes, swede, carrot and cabbage, followed by Queen of Puddings or ice cream and jelly. There is no separate dining room at Bracken Lodge but staff make the best use of available space. A table and chairs is available in the lounge, but the majority of service users remain in their armchairs to eat their meals, or take meals in their bedrooms. One of the care plans examined showed that the service user was reluctant to eat and indicated the various ways in which staff try to achieve a good nutritional intake. Staff discussed ways in which encouragement is offered and the cook was knowledgeable about this particular service users food likes and dislikes. Personal preferences can be accommodated. For instance, on the day of inspection one service user did not fancy either of the lunchtime options and made a request for pilchards instead and this was provided. Ms Flemming said that snacks and drinks are available from staff 24 hours a day. A member of staff commented, We try to make sure they eat well here and have a balanced diet. They can have drinks or snacks when they like. Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 A system is in place for dealing with any complaints. Service users are confident complaints would be listened to and dealt with appropriately. Minor amendments are needed to the Adult Protection policy to ensure that any allegations of abuse can be managed effectively. All staff have now received in-house training in Adult Protection issues, to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a complaints policy and procedure that has recently been updated. This is available in the Statement of Purpose and in the Information Handbook and is also displayed in service users bedrooms. No complaints have been received by the home or the Commission since the last inspection. Service users were not really able to comment on the complaints procedure. However, discussion with service users and a relative demonstrated they would feel able to voice concerns and feel their concerns would be taken seriously, and acted upon. The home has received many complimentary letters giving thanks for the kindness, care and patience shown by staff. Since the last inspection, the homes Adult Protection policy has been completely rewritten. This policy makes reference to the Department of Health No Secrets document and is now in line with this guidance, thereby ensuring that any allegations of abuse can be managed effectively. A few minor amendments are needed and Ms Flemming undertook to implement these straight away. All staff have now received in-house training in Adult Protection issues, to ensure a proper response to any suspicion or allegation of abuse.
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The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 and 26 Bracken Lodge provides a comfortable and safe environment for service users, with access to both indoor and outdoor communal facilities. The home is kept clean and there are no unpleasant smells, making daily life for all in the home more pleasant. EVIDENCE: Ms Flemming confirmed ongoing maintenance of the home and her intention of always seeking to ensure a safe environment for service users. A maintenance book details attention to any work required around the home. Documentation shows that equipment used within the home is regularly maintained to ensure the safety of service users. Records demonstrate that appropriate maintenance and checks of the fire warning system, emergency lighting and fire fighting equipment are taking place to ensure service user safety. Staff confirm that fire training and drills are also taking place at the required intervals, so they are fully aware of what to do in the event of fire. Radiator surfaces are guarded and hot water
Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 18 temperatures tested at baths are close to the recommended temperature of 43° C, to prevent any risk of scalding. Since the last inspection, one bedroom has been redecorated and repairs have been carried out to windows. New limiters have been fitted and the bars that were in place at some windows have been removed, creating a much more homely impression. Some new net curtains have been fitted and six new armchairs purchased. Bracken Lodge is an older property, which has been adapted for use as a care home. The amount of communal space is limited to one lounge at the front of the property and a small sitting area in the hall. The lounge is comfortably furnished and has a table and chairs at one end for activities, or where food can be served. Service users also have access to a garden. This area is mostly paved, with a central water feature and numerous tubs of colourful flowers. The garden is only used under staff supervision to ensure service user safety, as it is not fully enclosed. Staff at Bracken Lodge work hard to ensure the home is clean throughout and there are no unpleasant odours. Suitable facilities and procedures are in place in respect of laundry and the disposal of clinical waste. Since the last inspection, the laundry door has been replaced as it was showing signs of rot. The infection control policy and procedure has been updated and staff have received training in controlling any spread of infection. Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The numbers and skill mix of staff are sufficient to meet the needs of current service users. Bracken Lodge makes sure that appropriate checks are carried out prior to any new employment commencing, to ensure the protection of service users. The home has a staff induction programme in place for new employees but these records need improvement to fully evidence all of the training that is taking place. A training programme for all staff has been implemented, to make sure that staff are competent to do their jobs. EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrates there are a sufficient number and skill mix of staff to meet the present needs of service users. Ms Flemming heads a team of staff, most of whom are experienced in caring for people. A qualified nurse is on duty at all times. On the day of inspection the following staff were on duty: 8.00am – 2.00pm = 1 registered nurse and 3 health care assistants; 2.00pm – 8.00pm = 1 registered nurse and 3 health care assistants; 8.00pm – 8.00am = 1 registered nurse and 1 health care assistant. Care staff share responsibility for the provision of activities, some domestic tasks, the preparation of meals (other than the main lunchtime meal) and also the laundry. The home has now implemented a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. The two files
Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 20 examined showed that appropriate documentation is in place. Where staff are coming from abroad, the files demonstrate that appropriate information is gathered about the right to work in the UK and any possible restrictions on that work. It is suggested that staff files would benefit from a checklist detailing information such as the date on which the application form is received, when the candidate is interviewed, when references, Criminal Records Bureau disclosures etc have been requested and the dates on which such documentation is received, as well as the date employment starts. This would enable the manager to see at a glance how the recruitment process was progressing. Service users commented favourably about staff in the home, The lady who looks after me is very nice. I like it here, the people are kind. Since the last inspection, a considerable effort has been made to ensure that staff have the training they need to meet the needs of service users. Care staff have undertaken training in Health and Safety, Abuse Awareness, First Aid, Basic Food Hygiene, Infection Control, Care of the Dying and Incontinence Care. Nursing staff have undertaken training in influenza immunisation/anaphylactic shock and suprapubic catheters. All staff have also undertaken training in Moving and Handling, Dementia Care and Dealing with Challenging Behaviour and Aggression. Much of the training is in-house with some support from external courses. The home relies for much of its training on the use of videos. After watching the video, trainees complete questionnaires to demonstrate their understanding and competence. Staff commented, I want to learn as much as possible as it helps me do my job. We have done a lot of training lately and I think this has proved helpful to all of us. Work is still needed to improve induction and foundation training records. Although Ms Flemming and staff confirmed that this training is taking place, this is not fully evidenced in training records. Care must be taken to try and ensure staff complete their induction within the first six weeks of employment, before moving on to the foundation training. Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 35 Ms Flemming leads by example to ensure that service users receive a good standard of care. She is well supported by a team of nursing and care staff with all staff demonstrating an awareness of their roles and responsibilities. The home regularly reviews its performance and, wherever possible, seeks the views of service users, staff and relatives to ensure the home is run in the best interests of service users. Service users are assured of sound management of their financial interests. Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 22 EVIDENCE: Ms Flemming is an experienced Level 1 Registered Nurse and is currently undertaking the National Vocational Qualification (NVQ) Level 4 in management, which she hopes to complete by September 2005. Ms Flemming says she is a very hands on manager and operates an open door policy, which ensures that access to her at any time. She says feels it is important to remain open and accessible and this was demonstrated throughout the inspection. Ms Flemming feels that she is well supported by the registered person, Mr OFlaherty. He visits the home at least once a month and prepares a written report on the conduct of the home, a copy of which is forwarded to the Commission. Working relationships between the manager, staff and service users were directly and indirectly observed throughout the course of the inspection. They were amicable, yet professional, contributing to a welcoming and relaxed atmosphere, which was beneficial to all in the home. A visitor said, This is a friendly home and expressed continued satisfaction with the way the home is run. Staff spoke highly of the manager, She is a good boss, very fair but firm. She expects good results but helps and supports staff to achieve them. She has high standards and expectations and she expects staff to also achieve these standards. She is very supportive and approachable. Ms Flemming says she feels it is vital to have regular contact with service users in order to make sure that the home is meeting their needs and operating in their best interests. Quality Assurance questionnaires have recently been sent out to relatives and some of the service users. Comments from those that have been returned include: - A lovely, happy, well run home. I feel patients are treated with a good balance of respect and humour. Friendly, clean and efficient. Ms Flemming is now planning to provide quality assurance questionnaires for other visitors to the home. In order to protect service users, Ms Flemming says it is the policy of the home not to have any involvement in their personal finances. Therefore, all service users who are unable or do not wish to handle their own affairs, have a relative or other representative to deal with their finances etc. The home never handles residents monies but pays for services such as chiropody and hairdressing and keeps a record of what is owed. This amount is then invoiced to relatives or representatives for payment each month. Some relatives prefer to come and pay when visiting the home. Other relatives sometimes leave money in advance to pay for hairdressing etc, which is recorded and receipted. In this case, receipts are kept for any expenditure and given to the relatives concerned. Information about advocacy services is available to service users and their relatives within the home, should they need independent advice or support.
Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 3 3 x 3 x x x Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 18 Regulation 13(6) Requirement It is required that minor amendments and additions are made, as necessary, to the Adult Protection policy to ensure that service users are safeguarded from abuse. It is required that all members of staff receive training appropriate to the work they are to perform. Detailed records must be kept to evidence that staff are receiving induction and foundation training. It is required that the registered person continues to ensure the manager receives suitable assistance, including sufficient time, for the purpose of obtaining the NVQ level 4 in Management. (Previous timescale of 31/5/05 not met.) It is required that staff in the home are appropriately supervised. Care staff should receive formal supervision at least six times a year. Timescale for action 30/11/05 2. 30 18(1)(c) 30/11/05 3. 31 9(2)(b)(i) 30/11/05 4. 36 18(2) 30/11/05 Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 5 Good Practice Recommendations It is recommended that information about opportunities to visit the home prior to admission and the possibility of a trial period are included in the Service User Guide or Information Handbook. Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Unit 4 New Fields Business Park Stinsford Road Poole Dorset BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bracken Lodge D55 S20429 Bracken Lodge V230571 270705 Stage 4.doc Version 1.40 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
